WHO is an intergovernmental organisation with a central mandate that is focused on the protection, promotion and preservation of health globally, and although it has never been fully independent in its long history (even in the mythical times of Alma Ata), over the years, it has nevertheless tried to be a relatively autonomous policymaking body in global health governance and with respect to its normative functions. The panel and audience in Berlin were truly diverse! There were public health experts in the room, students, teachers of international health, journalists, writers, correspondents, representatives from civil society bodies and even some former WHO employees. The workshop dwelled on the past and present of the WHO and how its independence, legitimacy (representation and accountability are among the key factors legitimising the institution), and power to control (or at least substantially influence) the global health discourse are at stake now. On the one hand, the WHO’s constitution and landmark declarations like Alma Ata where health was declared a human right, give the impression that it has maintained its original stance and founding values, on the other hand, the organisation’s increased association with big corporate actors and philanthro-capitalists, speaks volumes about an ongoing internal ambivalence, even raising questions in some quarters about its integrity, in spite of the FENSA framework in place. Yes, you can argue that in the past the Rockefeller Foundation was also influential in public health programmes, but this appears to be an altogether different “multi-stakeholder” era. We seem to have reached ‘Peak Partnership” times.

Conflict of interest (CoI) issues are not limited to direct or indirect associations with profit-making organisations but run deep in the organisation. There are also concerns about the integrity and CoI of some members appointed for the WHO’s High Level commission on NCDs. The controversy surrounding the appointment of Mugabe as an NCD goodwill ambassador by the WHO is also still “fresh”, and this was flagged as a pressing issue which undermines the ability and legitimacy of the WHO as a coordinating agency for global health.

In this complex and difficult environment, the biggest question seems to be, how can the role of WHO as the central institution for global health rights and policies be resurrected? Or perhaps more aptly, these days, how can the WHO be(come) the “Queen” in the global health beehive, to quote a recent paper in BMJ Global Health; acting as a “meta-governor” in global health governance, and thus also injecting some (much needed) accountability into an otherwise rather unwieldy mix of global health actors and ‘stakeholders’? If not, the global health universe may continue to expand in all directions (and perhaps a few alternate universes as well), and we may see many more “World Health Summits” being held in parallel to World Health Assemblies, and ever more global health reports & Lancet Commissions that analyse in detail all the worthy global health causes, without producing a clear roadmap on how to tackle them in a holistic & systematic way.

The hope remains that the WHO can play the ‘integrator’ role in the SDG & planetary health era, in an arguably very volatile international environment facing huge geopolitical and other shifts, even if over the years the WHO’s dependence on donor agencies has only increased, via earmarked funding amongst others.

So, one obvious question is, “what should be done to reverse the tide?” As emphasised by the panel, the recent proliferation of global health initiatives has created a need for greater coordination and alignment at country level; member states also need to be more transparent and ethical. An expert panellist in the workshop said “the horse rider is as fast as his horse”, with the horse rider ostensibly being the WHO, and the member states, the horse (the WHO’s ability to run and lead in global health is contingent on member states). Still, I wondered, “is it really all about the member states?”, in a way, from my perspective at least, the WHO can always disagree and even disagree publicly with propositions that go against its values and constitutional mandate (even if it might not be ‘politically savvy’ to do so). The role of the WHO has changed over time, and the current scope arguably feels a bit too broad (in line with the ever expanding global health agenda), but that doesn’t mean the organisation should settle for a mandate that is restricted to just coordinating preparedness and response to emerging infectious diseases (as is desired by certain actors and member states).

The focus needs to be on setting strategic priorities, facilitating ownership by member states (including assisting with decentralisation in many multi-level/federal member states) and calling upon them to increase assessed contributions, although so far most don’t seem to be “answering the phone” on the latter issue. This week’s rather underwhelming response of member states at a pledging conference on WHO’s Emergency Contingency Fund demonstrates this, and with such a weak response to existing (health security related) commitments, one can imagine how keen they are on increasing assessed contributions.

Arguably, in today’s “multi-order” times and with the current gridlock in global governance, a substantial increase in assessed contributions might seem unrealistic. But let’s keep the brave young Americans in mind who are also trying to break a seemingly insurmountable gridlock.

Reforming the WHO’s governance structure and emphasising its leadership role alone won’t be enough, reforming finance and partnership structures are equally important, certainly against a backdrop of growing associations with non-state actors. The implementation of FENSA, is for instance, to be watched closely; one does not want the likes of Bloomberg, Gates & others running the (WHO) show altogether, let alone some of the less benign corporate actors lurking in the NCD background.

As described in this workshop, many member states seem to have lost their appetite for real change in the WHO, and this includes a changed role in global health governance. However, to resolve the current conundrum in global health governance, a clear roadmap and a strong policy stance regarding the engagement with member states and other non-state partners are urgently needed at the WHO. Non-state actors with a good “public interest” and those with “no interest at all” (or worse) need to be clearly differentiated from each other, and the financing of these organisations needs to be scrutinised in greater detail. Strengthening and empowering community/citizen engagement and promoting a real dialogue with community organisations is also important, and member states should all support this move to involve civil society more, rising above their political and other differences. We are nearing the end of this piece, so I hope you’ll allow me a bit of dreamy idealism! Finally, being the global body for health, with the DG envisioning “a world in which everyone can live healthy, productive lives, regardless of who they are or where they live”, it is high time the organisation helps speed up the death of neoliberalism and austerity (for public services, that is). Again, there is not much appetite for that, as many member states don’t allow the WHO to take such ‘politicised’ positions. But let’s just wait until Comrade Corbyn (and perhaps also Comrades Sanders/Biden) are in charge in the UK/US!

All in all, the debates I attended in Berlin and the concerns raised by panellists and people in the audience were very significant. These sorts of analyses can inform an action agenda which can in turn be used to engage with the WHO and its reform process.  Having become much wiser, I then indulged in a bit of sightseeing in Berlin, a city with a history which I hope has also made humanity a bit wiser in the previous century.

The recent MeToo campaign against sexual abuse and exploitation which went viral, proves that even in the well-to-do societies, women are not always treated equally. With people from many countries across the world supporting the movement, it has become one of the most successful social media campaigns of our time, and many cases of sexual harassment and exploitation have emerged. The majority concerns the media and entertainment sector, and includes allegations against powerful people like Trump and well-known scientists like RK Pachauri. In many of the cases that have come to light, famous (now infamous) personalities have been sanctioned financially, legally or simply through societal reprobation. The very long list of people MeToo has affected, includes well-known figures like Javier Palomarez and billionaire Steve Wynn, although many of the accused have denied the allegations.

However, we cannot deny that the MeToo campaign itself runs into gender imbalance territory, with almost all the voices that we have heard being feminine voices; the so called “silence breakers” for example, are all women. It almost feels as if men do not have anything to contribute to the campaign. This is not unusual, as invariably most campaigns for gender equality tend to be about women’s equality (this is of course natural, as women have traditionally being the “disadvantaged” gender in most societies), and the fight is often left only to women. Be it Hollywood in the west or Bollywood in the east, the MeToo campaign speaks out mainly against cases of women’s harassment by men, and invariably these allegations come from women.

Speaking out against sexual harassment seems to be very difficult for men, for example gathering male voices even within academic circles, which are open and flexible (the Emerging Voices for instance), to speak up and write about the issue is a challenge. There’s a certain reluctance to do so, and not just on International Women’s Day (which would be understandable). Reasons for this could include the fear of getting thrashed by women’s groups for one reason or the other (men wearing black at the Golden Globe awards this year in support of Time’s Up movement and the reaction) or just a perception that the MeToo campaign is a feminist concept and that is better handled by women. Although some men can defend themselves from allegations of “arm folding”, by saying that they have tried to do their part for the movement, with campaigns such as #Askmoreofhim campaign in support #MeToo, these efforts have remained very minimal, local and less vocal.

Although the current campaign about exposing and punishing people who sexually abuse and/or exploit others is more than needed, in my opinion, through MeToo we have an opportunity to give more attention to even bigger issues like equality for women. A good example is India, where despite the existence of strong women rights movements in recent years, hardly anything has changed both in terms of sexual harassment and general attitudes. The country has many cases of girl feticide, “unwanted” girls, perinatal maternal deaths because of the unimportance of women’s health in families, unequal pay for equal jobs, fewer women in leadership roles and poor representation in global events. These cases of course span many sectors such as: health, education, sports, media, movies and politics. Incidents that occur in the movie and media industry come to light more easily, for the obvious reason that selling stories about the fall from grace of powerful men is lucrative. However, it is high time MeToo expands to include the struggles of women fighting for equality in other sectors, and in other more difficult settings. That is starting to happen, but not fast enough.

The obvious solution is to use MeToo as a vehicle for campaigning for other women’s rights issues. It should include strategies for changing societal attitudes, increasing the numbers of women in leadership positions, and improving representation and participation in decision-making processes from the global level to the local level. We also need strategies to help everyone understand that decisions around women’s health and well-being should depend upon their preferences, and these should be supported by men.

So, on this International Women’s Day, let us join hands, both women and men, to make the fight for real gender equality, not just a fight fought by women! Many cases of sexual misconduct have already surfaced in celebrity circles, since MeToo went viral in October last year. We do not want another Weinstein, but we also do not want women like Milano, Thurman, Meryl Streep, and a few outliers in Bollywood to feel that they are lone combatants in the fight against sexual abuse and exploitation. Instead, the problem must be eradicated both in celebrity circles and in normal everyday societies, and to do this, the urgent  participation of men as brothers, husbands, fathers, and friends is required. Men should become allies in the global fight for gender equality, they should be more vocal in public forums, preferably without self-censoring or fear of being “Damonized”, and they should support and promote campaigns like MeToo!

As expected, at the start of the Board meeting, member states agreed to discuss all items on the agenda, including the  13^th General Programme of Work (13GPW).  Ahead of the EB meeting, a lot of analysis and critical reflection on the ambitious 13GPW and its budget implementation plan had already taken place (see here and here for example), which clearly suggests the focus of the global health community on WHO at  this important point in time, and the high expectations towards the new DG in many corners.

DG Tedros, also known as “the people’s DG”, was quite emotional in his speech on the opening day as he cited the (very recent) murder of two polio healthcare workers (a mother and her 18-year-old daughter) in Pakistan and expressed his utter sadness over the issue of violence against health workers. Tedros then laid out his vision on the future of WHO, in the form of the (now revised) 13GPW, and how changes like a greater focus and prioritization (of UHC & people-centred care, a healthier population, health emergencies), a more detailed implementation plan, and clarification of WHO’s position on its normative role (vs a more operational one) have taken place since the last EBSS in November. He then emphasized that WHO is committed to transformative change: strategic priorities are being set, resource mobilisation revamped, and Tedros himself aims to set an example by having a dynamic leadership structure at the highest level, including – as you know – many women. All in all, he said, 2018 will be a “year that will determine what WHO looks like in the future”. Put differently, this will be a “make or break” year (or 18 months) for WHO, both in terms of structure & functioning. The GPW, the transformation, resource mobilization and strong leadership all need to go together, Tedros emphasized. But of course, real commitment from the member states will also be required if Dr Tedros and team are to pull off this ambitious agenda in the coming years. As he mentioned in November, “It takes two to tango”.

In the discussion on the GPW and its implementation plan this week in Geneva, the multi-stakeholder approach and financing of this ambitious agenda were some of the main matters of concern.

On partnerships and multi-stakeholder participation the new DG used fairly strong words, saying that a truly dedicated multi-stakeholder partnership (comprising member states, the private sector, and civil society) would only build a united force for a common goal. He responded to conflict of interest concerns raised by some civil society speakers who claimed that there’s a big risk that more explicit involvement of the private health sector might lead to undue commercial influence in the programme of work, distorting progress towards health equity (thereby impeding progress towards UHC and other health SDG targets), and norm-and standards setting. Tedros addressed their concerns in a quite emotional and open manner, as is becoming his trademark. He told the audience that, with greater faith in 13GPW, it is possible for all to join hands while keeping conflicts of interest close to zero. Tedros was perhaps overdoing it a bit, here, as it was rather obvious from their interventions that some countries (like the US, Italy) were keen on a (far) more prominent role for the private sector. And as you know, the Americans are still a big WHO funder, at least for now. Conflict of interest risks will probably remain an issue till long after Tedros has moved on. Anyhow,  the DG called on everybody to work together and rise above individual egos and pet priorities. There was not much discussion on the implementation of the Framework of Engagement with Non-State Actors (FENSA), in the light of the GPW assumption that multi-stakeholder participation can be the model while remaining an independent and transparent global health body.

Resource mobilisation for the GPW was another major point of discussion under the specific agenda item. Days before the EB meeting, the Programme, Budget and Administrative (PBAC) committee got together. The committee estimates in its report that a total of 10.8 billion USD will be needed for the implementation of the GPW over the next five years for the base segment of the budget. Based on the already approved programme budget 2018–2019, this represents a US$ 2 billion increase over the five-year period, or an increase of about US$ 400 million per year. Keeping the GPW in mind, a programme budget with two segments was proposed, namely: a base segment and scalable operations. As per the PBAC report, the scalable operations segment would include emergency response, the remaining activities of the Global Polio Eradication Initiative and special projects – special projects are typically unforeseen negotiated projects at the country level, which are essential in implementing the strategic priorities of GPW 13. However, the budget discussion was postponed at this EB meeting. It will be discussed at EB143 and the World Health Assembly in May, to be then finally adopted/approved at the WHA 2019. But the Secretariat will work on “transformative resource mobilization”, it was assured. PBAC made it clear that adoption of the GPW did not imply adoption of the budget estimated for it. Like in November, the DG called upon member states to provide more un-earmarked funding and move from just quantity of funding to better quality of funds. With more flexible (un-earmarked) funding, there will be greater scope for prioritizing, Tedros argued. However, in the EB there was not much of discussion on how to increase the assessed contributions, signalling a kind of (weary?) acceptance of the fact that most of the budget will still primarily come from earmarked funding. There was hardly any discussion on chronically under-funded areas like NCDs and access to medicines.

To conclude: it is high time now to see the implementation of the GPW on the ground (which will only start in 2020, though, according to the plan) and move from words to action, in line with the “Move the caravan on the road” jibe by the Turkish spokesperson.  A  revised (final) draft of the GPW is already out, incorporating some of the comments and feedback received from member states. If all goes well, this GPW will be agreed upon and approved in the EB meeting in May 2018 (143^rd EB) and the World Health Assembly.

And then the real work can start.

UHC, by definition, is “the desired outcome of health system performance whereby all people who need health services receive them, without undue financial hardship.” UHC cuts across all (or at least most) health related sustainable development targets.  Zooming in on India, then: despite the fact that the country is one of the fastest growing economies in the world, India’s public healthcare spending still stands at a meagre 1.2% of its GDP.  This is very low as compared to minimum global requirements and is a rollback on a previous commitment, and stands against its commitment to achieve UHC. However, finance is not the only challenge. It may seem obvious that with increased fiscal space, many developing countries have the potential to achieve UHC but as the Karnataka example shows, many other aspects (vested interests, political economy issues and a weakened public health system) play a role in making progress (or not). With poor infrastructure (including thin human resources!) at public health facilities coupled with questionable quality of services at both public and private government set-ups, and government failing to control an unruly private sector, the achievement of UHC in the country, even in the long run (by 2030), is surely in jeopardy.

We are already over two years into the adoption of SDGs, the first ever (really) “global” to-do list for a fairer, safer and healthier world (by 2030), and nothing seems to have gotten more attention in the global health community than SDG target 3.8, UHC, and rightly so. Yet, 400 million people globally still lack access to essential health services and 150 million are being pushed into poverty each year due to health related costs. We cannot just wait and wait till the end of 2030; a typical “business as usual” approach will take us nowhere, we all agree. WHO rightly pointed out  that all countries (i.e. at all income levels) can do more (even though some of them won’t be able to achieve UHC by 2030), to improve health outcomes and tackle poverty, by increasing coverage of health services, and by reducing the impoverishment associated with payment for health services.

In September, at the Social Good Summit in New York, dr. Tedros, the new WHO DG, called upon countries to “come to their senses” and “make UHC happen”. India presents valuable insights for countries in the developing world to realise this unique challenge, “come to their senses” and of course adopt bold solutions on the UHC path.  The Indian case shows that’s anything but straightforward, but episodes like the recent one in Karnataka still provide lessons for other countries. As we are inching towards UHC Day in about 10 days, it’s high time we realise what needs to be considered to move towards UHC:  definitely it’s not just about (lots of) money (more public money for health surely helps!) but also about a change in set rules in order to be able to manage that money more effectively.

Gender equality is intrinsically linked to sustainable development and vital to the realization of human rights for all. Gender inequities, as one report tells us, can for example damage the physical and mental health of girls and women.  Many of us working in global health and social development are familiar with the literature and discourse on gender and its role in the wellbeing of entire populations. And yet, attending some sessions on gender at the Fourth Global Symposium on Health Systems Research in Vancouver (HSR 2016)  got me [as a male participant] thinking – where are the men?

Much better publicized than a health systems research conference were the recent worldwide Women’s Marches. A recent blog on a Women’s March in Geneva urged us [men] to join the demand for equal dignity and rights, irrespective of gender.  And indeed, the marches saw people come out in astounding numbers the day after Trump’s inauguration – yet, among the marching masses, men were still a minority.  And so I raise the question again: where are the men? And if we speak of gender inequalities, why are only women – who are the ones at the receiving end of the inequities – alone in their efforts?

Our experience at the Vancouver symposium

Returning to my reflections from the Vancouver conference the gender gap was perhaps most evident there in the many “missing men” at gender related sessions, as others have noted before in other contexts. Take as an example, an afternoon session on the opening day of the symposium on “power and prejudice: how does inequity play out in the institutions and processes of health systems research?”

The session on power and prejudice at the HSR2016 started with participant discussions on three main issues: women’s participation in global health programs, health research, and the health workforce. We were asked to share individual and community experiences of women’s roles in these three areas in order to identify barriers in the participation of women in leadership roles, and to come out with possible solutions to tackle issues associated with women’s leadership in global health initiatives.

Alas, there were only two men in the room: my colleague and I. For a brief moment we wondered if  we had come to the wrong session (one not related to the conference at all) or whether we had overlooked some crucial [read: gender barrier] eligibility criteria for that particular session.  At the very least it appeared as though  men did not have a role in discussions on the  dignity, rights and equity in gender context. And this was among a relatively progressive and liberal community of  health policy and systems researchers!  Indeed, one can argue that the session may have faced stiff competition from other concurrent sessions, but I don’t believe that is a legitimate reason. It was a great pity!

Relatively few all-male panels

On the bright side, all male panels, or “manels”, were rather rare at this symposium, unlike at some other high profile global health events. Yes, earlier that day at the conference we had seen an all-male panel discussing maternal health and rights, but it was something of an exception in Vancouver – this was  one of the “few unfortunate manels.”  Overall I acknowledge the conference’s attention  to topics on equity, rights, gender and ethics. Yet, my dilemma remains, “Has the mindset really changed?”

Gender equality and its equation with women leadership in health

Today even as we have greater representation of women in the health workforce inequities are evident as in most (if not all) countries women tend to take on more “caring” roles of nursing, community health workers and as home carers, whilst their numbers in other healthcare cadres, particularly at leadership positions are still low. We wonder even if in some of our low-resource settings, if it actually were men in community health worker positions such as the Indian ASHAs, whether they would have better salaries, career pathways and designations; or whether their work would be considered as voluntary or instead recognized as being an indispensable part of the health workforce.

The need for gender equity is crystal clear, as well as the need for more women in leadership positions. Yet, it’s also obvious that women’s representation should go further than their mere presence at panels, leadership roles etc. True empowerment and equity will come from equal participation of men and women in addressing challenges and barriers to protecting dignity, rights and political participation.

Challenges of our time, and why we need women leaders in global health now more than ever

The gender debate takes place against a worrying and rapidly deteriorating international backdrop. Surely these are troubled times – with the unity, rights, equity and gender agendas increasingly threatened by nationalism, and  intolerance towards vulnerable populations, including women and minorities.

It was heartwarming and much needed to hear Hillary Clinton say, earlier this week, that “the future is female”. Despite everything.  But men need to say this too, they need to come out in support of women (and female leadership). Men and women must speak out collectively against the glaring and growing injustices all over the world.

Discussing gender equality beyond economic, political and educational boundaries should be the first step. Since the inequities among the sexes are so wide and deeply embedded, efforts to push women ahead, to narrow, if not close the gender gap are more urgent than ever today. As a male member of society, I feel more men should also be encouraged to join the efforts currently in place. Self-reflection on our own power and privileges as men is a must before we start anything. Last but not least, we need to bring about social change, as individuals, researchers, policy makers, implementers – among ourselves, among societies and within our smaller workspaces.

As a start, I certainly hope I’ll see many more men present at the sessions on gender in Liverpool!

First Off, young energy, a diverse group of participants, and emotions

The stage had been set: early November 2016, the Emerging Voices for Global Health 2016 (EV4GH)  program reached Vancouver, to train before the fourth Global Symposium on Health Systems Research (HSR 2016). The EV4GH program is a multi-partner blended training program for young health policy & systems researchers, decision-makers and other health system professionals. It is also one of the thematic working groups of Health Systems Global now, and organized in parallel to the biennial global health systems research symposium. After the online distance coaching which preceded the face-to-face training, 40 brand new EVs from all over the globe arrived in Vancouver, already familiar with each other through their virtual interactions, excited and ready to get to know each other in person.

As one of the 40 new EVs, I too felt the surge of adrenaline this energetic and passionate group of young health researchers brought to our training venue and home for the next three weeks in a hotel in downtown Vancouver. The name of the hotel – Sandman – felt totally out of sync with the drive of all these young people. Unless, of course, you think of Metallica’s “Enter Sandman”!

A global platform, and an innovative learning experience

The EV4GH program introduced us to global health experts through “Big Talks” – sessions which gave us the opportunity to discuss global health with the likes of Kelley Lee and Wim Van Damme. “Small Talks” introduced us to essential digital communication platforms and social media – critical towards the dissemination of our work, interaction and debates on areas of interest. Research communication and discussions were the core of our training. These were critical in developing in us the capacity to deliver our research and work more effectively across a wide audience. Talks, tweets and tortilla wraps sum up much of the EV4GH training!

Time always flies when you’re having a good time. We also made interesting visits to the Canadian health system and had an ‘Evidence to policy’ day. After only ten days in Vancouver, the Emerging Voice Pre-Conference was already upon us! At this event, the EV Batch of 2016 presented their work to a truly international audience of experts, healthcare managers, lawmakers. The presentation of the opening plenary (whereby we all had to attract participants to our respective sessions) was rather innovative with short skits, role plays and singing regional songs. Before we knew it, the EV4GH training and HSR Symposium were over in a rush of presentations, networking and chicken wraps (again!). They do seem to like chicken wraps in Canada for some reason. In the two months since, I continue to be struck and inspired by the learnings, reflections, and memories!

I’m often asked how I benefitted from a program such as this. I don’t have a clear answer, or maybe I do not want to be caught up in semantics. Maybe I want to avoid being categorized or labelled as an “emerging voice” or “emerged leader.” What I can say is that theEV4GH helped me build confidence. Such a program may encourage the young to raise their voices, speak about their work to a wider audience. It also provides an excellent platform to network and enables young researchers to navigate a big conference. Equally important is the opportunity for researchers from lower- and middle- income countries to participate in global fora.

It is no wonder that this program, with its youth focus, is so unconventional and fun! As the founding father of this blended learning program, Wim Van Damme says, “With this program, there are no set rules! Everyone is really free and flexible to adopt a style of their own in communicating their evidence while being grounded in the reality of their part of world”.  According to him, the EV4GH venture trains a new generation of fearless global health change makers who are critical in their assessment, and ready to take on the challenges of our time.

This is especially relevant today, unfortunately.  As you might recall, the US elections took place during our Canadian EV4GH time. The result was unexpected, leaving many of us feeling as though the world we knew had ended. It felt for a moment tweets were more powerful than press releases, and how just tweets from an unorthodox politician – now widely referred to as “Commander-in-Tweet”   – rising to power can turn the world upside down. This result brought a sense of utter desperation to the EV camp all of a sudden, resulting in a post-election blues. On the bright side we rode that wave of emotions together, never once losing sight of our collective global health goals.

Many countries in the “North”  are now witnessing what I call a “Trump, Brexit, and rise of nationalist Populism” syndrome ( for example: Trump’s “Bringing the country’s spirit Back” campaign), while many in the Global South are witnessing a  sort of “negative equation” with civil society and human rights bodies. These are all vital reasons why we need young people, their energy, and importantly a platform like EV4GH to fuel change. More than ever.

Expert quotes, and energy to the young voices

And fuel we will. The New Year started with an (appropriately bearded) Emerging Voice (EV) counting on some pearls of wisdom for young health system researchers from the fourth Global Symposium on Health Systems Research. I have two favorites from the article, “We need the energy of the Emerging Voices to tackle the enduring challenges of our times…”, and “do capitalize on your can-do & must-do enthusiasm when you’re young (as when you grow older you often get (too) comfortable in your ways); and challenge power, wherever you feel it’s appropriate…”

While these quotes are self-explanatory, and one can see the connections between young researchers and a “can do” enthusiasm, we cannot deny that the “young” thinking and enthusiasm is not always something that comes with young age – see for example Lucy Gilson’s inspiring speech at the Emerging Voices for Global Health 2016 closing plenary. For Gilson (always full of energy!), it is vitally important for young researchers to question and build on existing theories.  This perhaps leaves us with a challenge for young researchers: how to practice all these learnings in real life?

Challenges ahead, keeping up the spirit and energy, identifying possible way of collaboration

As Peter Annear articulated during the HSR symposium, seeing all these bright young minds at work might be the best part of an event of this magnitude. While I cannot deny this, I also take courage to say that the energy should last long enough to carry to the next version of the symposium and all such symposia to come.

Referring to the recently concluded symposium theme, “Resilient and responsive health systems for a changing world,” if resilience cannot be developed overnight, it should be a continuous and sustained process towards strengthening a health system. For this, the engagement of young voices and leaders is equally important, and hence the work of the EV4GH cohort must continue beyond the conference. Social media, research collaboration, professional groups, critically reflecting and assessing each other’s work, peer learning and many such modern approaches allow us to remain in touch and grow further.  The opportunities to engage are plenty. These informal links (groups between EV/EV alumni), and more structural mechanisms such as a governance team, secretariat, dedicated communication team, regional hubs… are all important. A strong leadership is also beneficial. Everyone appreciated the sincerity and quality of steering provided by the current chairs and governance team in the recently concluded edition of EV4GH – we need more of it- to take this network forward together with other developmental partners. And yet, young groups such as ours (EV4GH) face the challenges of limited partnership and resources. Support from mature groups such as Health Systems Global, and other established global health research hubs is the need of the hour. But the prospects are looking good.

For the moment though, I will continue to bask in the interest and passion of the EV4GH. To go beyond borders, to be more confident, vocal and expressive and yet rooted in reality. Heck, being part of a global network of young global health scholars now, I’m already humming the Beatles!

My country is not alien to this context and process. Of late, when the whole world just focused on a single election and individual, predicting “not so happy” consequences and a whole lot of uncertainties, we Indians were not so startled. Yes, being a stable yet very peculiar economy in our region, sensitive to foreign investment, the Indian rupee, market equities, and trade did slide for a moment following the incredible (unexpected) US electoral results. However, we were not as surprised as many others, perhaps because we had other things to be surprised at. ……(Coincidentally the US election results and the demonetization announcement in India happened on the same day)……   I guess, collectively we are now adjusted to ‘uncertainties’- although with positive hopes. As Indians, we are seeing the nation as under development, in the making, taking re-birth now and then, under what they call the “charismatic” leadership of Modi and his brigade. For example: Make-in India and Digital India are a few of the ambitious campaigns led by Modi and his current government which have the potential to build a next generation vibrant India. However, what the future has in store in reality is deeply uncertain given the current challenges  attached to many of the (other) campaigns which at times I feel are more ambitious and less realistic. Take the example of the current demonetization drive in the country. While one agrees that this was an important move in cracking down on the so called black money- corruption around the financial instrument of the land, one also cannot shy away from the fact that more inconvenience was caused to poor people lining up in large numbers in front of the ATM counters waiting for withdrawing new currencies than for those for which this move was meant in the first place. Yet another bright instance was the government’s plan to make healthcare a fundamental right just days after slashing the health budget to adjust for the fiscal deficit. While on the one hand, the government promoted skill building of young minds through schemes like the Prime Minister’s Skill Development Scheme, on the other hand, as reported, we saw a huge amount of cutting down in foreign funds for non-governmental organisations under this government.  Amidst current challenges, people are confused about the future.  Maybe the intentions of the government of the day are perfect but I feel those are often not reaching people the way they should have reached them.  So thick and so fast things are happening in my country, which influence people in their daily life, these kept people busy!  People  who are at the same time experiencing many of the global issues of our time at home, in their own backyard.

Be it the widening disparity between rich and poor, the increased occurrence of both communicable and non-communicable diseases, air pollution, anti-microbial resistance, an unprecedented temperature rise, heavy rainfall, …  the sub-continent and its people experienced them all, many of the intriguing global issues of our time,  in 2016.

Keeping aside what had happened so far this year, I am more concerned about how those things happened, and about their short term and long term repercussions. The intensity with which some existing challenges resurfaced and some entirely new issues arrived on the global scene; that truly took the world by surprise. In my view, four things stood out and drew attention from all corners in 2016: continuous acts of terrorism, the deepening climate change impact, the emergence of new killer diseases (with after Ebola now also Zika becoming a household name), and as if those were not enough, unexpected and huge political turmoil (with Brexit and the US election as the most obvious examples, but by no means the only ones). Series of terror attacks in major hubs all across Europe; again this is something we’re, unfortunately, quite familiar with here in India and in its so called heavenly state of Jammu and Kashmir. We talk of  global health, we talk of humanity and peace. Yet, there are places on this planet where people are living day and night in deep fear, just to escape from being killed; for them rest bothers least! The seemingly neverending and horrendous Syrian crisis was a true testimonial to this but it’s certainly not the only place to be on the receiving end. And then, of course, there were the obvious refugee and immigrant issues!  Again I will stress, everything has really blown out of proportion this year. In the coming year at least, we’ll have to concentrate on certain challenges, and perhaps live with the uncertain impact of the measures we take.  That reminds me of climate change, and its science. The Paris agreement may be the only silver lining in climate change matters this year, but it also comes with lots of promises made and not without lots of (possible) hiccups as well from parties involved. Even sometimes I feel, the climate damage we experienced this year was much larger than what would/should have happened in a so called “business as usual” scenario. The sheer devastation of the heat strokes in  Telangana, India and Karachi, Pakistan , the havoc caused by rain made floods in metro cities like Chennai, Mumbai, and Delhi, … throughout the year I felt like this. Rainfall was so heavy at times, and drainage- traffic situations were so bad in big cities, that it even resembled flood at times. Take the example of India’s capital city of Delhi: the visiting US Secretary of State had to make the infamous “boat” remark considering the situation then.  On air pollution, again some well-known Asian regions top the list: while China was (still) ‘top of the pops’, India was not far behind. Reportedly, during Obama’s visit to India earlier this year, the US embassy had purchased over 1800 air-purifiers and still it was reported how the visit could have cost the president some hours of his life due to air pollution.

For all good reasons, as if the story and journey of a humble tea seller rising to power is not enough at home, here in India for us, we see at the global level how expert predictions falter and falter big time, in a hardcore businessman rising to power in the world’s most powerful democracy …with all its negative vibes though, just before we thought of completing the year with some cheer.  Against this backdrop, I would prefer not to conclude “conventionally” here by proposing some so called “realistic” solutions; rather I would urge the international community, my fellow colleagues and friends to just realize that we’re living in challenging and uncertain times and then use some sort of reality check when  coping with the challenges. Often, indeed, we do know good solutions and ways to address challenges. In many cases, solutions tend to come from better communication and a collective understanding of the evidence we have available. And one thing I can safely say which will not cost us anything is this: let us not lose hope. I am sure opportunities will come up, let us capitalize on those whenever, wherever and in what form they come!

On that note, best wishes for the Christmas holidays, and hope opportunities will prevail over challenges in 2017!

demonitization in India

Syrian refugees